食管上括约肌测压与158例贲门失弛缓症患者症状及预后的相关分析  

Analysis of upper esophageal sphincter pressure with symptoms and prognosis in 158 patients with achalasia

作　　者：刘杰[1] 林寒[1] 周玮[1] 张玲[1] 李貌[1] 赵九龙[1] 钱维[1] 邹多武[1] 

机构地区：[1]长海医院消化科, 上海200433

出　　处：《中华消化杂志》2016年第1期30-34,共5页Chinese Journal of Digestion

摘　　要：目的探讨贲门失弛缓症（AC）患者食管上括约肌（UES）压力分布状态，并分析 UES 测压异常与临床症状及治疗效果的相关性。方法回顾性分析2012年1月至2014年12月行高分辨率食管测压（HRM）检查的158例 AC 患者。依据患者是否存在 UES 测压异常分为 UES 测压正常组和异常组，测压异常组再分为 UES 低压[UES 静息压＜34 mmHg（1 mmHg＝0．133 kPa）]、UES 高压（UES静息压＞104 mmHg）和 UES 松弛障碍（UES 松弛压＞12 mmHg）。采用方差分析、Kruskal-Wallis H 检验和卡方检验比较各组患者临床资料与动力特征。结果74例（46．8％）AC 患者合并 UES 测压异常，UES 松弛障碍占多数（35例，47．3％），其中 UES 低压患者年龄[（60．6±10．1）岁]明显高于 UES 高压[（43．9±11．1）岁]和松弛障碍组[（46．8±16．3）岁]，其病程[10（4，30）年]也明显长于 UES 高压[6（1，10）年]和松弛障碍组[8（3，15）年]，差异均有统计学意义（F ＝7．983，H ＝13．816，P 均＜0．01）。但异常UES 与患者主要症状并无相关性（P ＞0．05）。AC 亚型3分类显示Ⅱ型 AC 占55．7％（88／158），UES 测压正常组与异常组中Ⅱ型 AC 分别为46和42例，均占多数（54．8％、56．8％）。共有123例最终进行经口内镜下肌切开术（POEM），其中合并 UES 测压异常者占47．2％（58／123）。两组术后1个月症状改善满意率均超过85％，Eckardt 评分也明显下降，两组治疗效果差异无统计学意义（P ＞0．05）。结论 AC患者多合并 UES 测压异常，其中 UES 松弛障碍最常见。UES 测压异常与其主要症状并无相关性。UES 压力状态对 AC 患者 POEM 治疗效果并无预测作用。Objective To investigate upper esophageal sphincter （UES）abnormalities in patients with achalasia （AC）,and to analyze the correlation between UES abnormalities and clinical symptoms, treatment efficacy.Methods From February 2012 to December 2014,158 patients with AC and received high resolution manometry （HRM）examination were retrospectivly analyzed.According to whether with UES abnormalities,patients were divided into UES normal group and UES abnormal group.Patients of UES abnormal group were sub-divided into UES hypotensive group （UES resting pressure〈34 mmHg, 1 mmHg=0.133 kPa）,hypertensive group （UES resting pressure〉104 mmHg）and impaired relaxation group （residual pressure〉12 mmHg）.Analysis of Variance,Kruskal-Wallis H test and Chi square test were performed to compare the clinical data and dynamic characteristics of the patients in each group. Results A total of 74 （46.8%）AC patients had UES abnormalities,the majority of whom were impaired relaxation （35 cases,47.3%）.The age of patients in hypotensive group （（60.6 ± 10.1 ）years）was significantly older than that of hypertensive group （（43.9 ±11 .1 ）years）and impaired relaxation group （（46.8±16.3）years）,and the disease course （10 years,4 to 30 years）was obviously longer than that of hypertensive group （6 years,1 to 10 years）and impaired relaxation group （8 years,3 to 15 years）,and the differences were statistically significant （F = 7.983,H = 13.816,both P 〈 0.01）.There was no＆amp;nbsp;correlation between UES abnormalities and clinical symptoms （P 〉0.05 ）.The results of AC subtyping indicated that type Ⅱ AC accounted 55 .7% （88/158）.Type Ⅱ AC cases number of UES normal group and abnormal group was 46 and 42 cases,both was majority （54.8% and 56.8%）.Among these patients,123 patients finally received peroral endoscopic myotomy （POEM）,47.2%（58/123 ）of whom had abnormal UES.More than 85 % patients were satisfied at one month after the operation.And Eckardt

关 键 词：高分辨率食管测压 食管括约肌 上段 贲门失弛缓症 经口内镜下肌切开术 

分 类 号：R571[医药卫生—消化系统]